Clinical Health Updates

Low dose (40 mg/d) doxycycline effective for acne rosacea

Clinical Question:
Is low-dose doxycycline effective in the treatment of acne rosacea?

Bottom Line:
Low-dose doxycycline (40 mg controlled-release) is more effective than placebo in the treatment of acne rosacea. Side effects were minimal. Less than one fourth of actively treated patients reported near or complete clearing of their lesions, however, so many patients may still request alternative treatment, including a higher dose of doxycycline. (LOE = 1b)

Del Rosso JQ, Webster GF, Jackson M, et al. Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. J Am Acad Dermatol 2007;56:791-802.

Study Design:
Randomized controlled trial (double-blinded)

The optimal dose of doxycycline necessary to treat acne rosacea is unknown. These investigators enrolled 537 patients in 2 separate studies conducted at different times to randomly receive in a double-blind manner (concealed allocation assignment) doxycycline (40 mg controlled-release daily) or matched placebo. Eligible patients were otherwise healthy adults, 18 years or older, with moderate to severe rosacea (10 to 40 papules and pustules, telangiectasia, moderate to severe erythema, and 2 or fewer nodules). Individuals blinded to treatment group assignment assessed the primary efficacy end point, defined as the mean change from baseline in total inflammatory lesion count (papules + pustules + nodules). The mean total lesion count at baseline was 20. In addition, patients were rated according to whether their disease was completely clear or near clear. Follow-up occurred for 97% of subjects at 16 weeks. Using intention-to-treat analysis, the mean change from baseline lesion score was significantly lower in the doxycycline group than in the placebo group (-1.8 vs -5.9 and -9.5 vs -4.3 in studies 1 and 2, respectively). Significantly more subjects in the doxycycline group also reported near or complete clearing of their lesions (22.3% vs 12.3%; number needed to treat = 9; 95% CI, 6-23). Adverse events were minimal to mild in both treatment groups.